Infliximab as an alternative treatment for Behcet disease when other therapies fail
Infliximab as an alternative treatment for Behcet disease when other therapies fail
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DOI：
10.1097/mpg.0b013e3181346b60
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发表时间：
2008-02-01
影响因子：
2.9
通讯作者：
Pehlivanoglu, Ender
中科院分区：
文献类型：
--
作者：
Ugras, Meltem;Ertem, Deniz;Pehlivanoglu, Ender
BEHçet病(BD)是一种慢性、复发性、多系统炎症性疾病，以复发性口腔和生殖器溃疡、皮损和葡萄膜炎为特征(1)。罕见的表现包括胃肠道受累、关节炎、癫痫发作和血管损伤。BD的胃肠道受累称为肠-白塞氏综合征，主要累及回盲部和结肠。口疮累及肛周是一种相当罕见的BD临床表现，通常仅限于儿童时期。肠Behçet综合征最常见的症状是腹痛、恶心、呕吐、大便带血或不带血的腹泻以及便秘。BD的胃肠道症状通常出现在口腔溃疡发病后4~6年。肠道病变通常对药物治疗有抵抗力，手术治疗后经常复发。据报道，在以色列的一项研究中胃肠道受累的频率为零，在日本的一项研究中为60%，在土耳其的这一比例为2.8%至5%(3)。治疗BD的主要目的是改变炎症反应。几种药物被用于治疗BD，如硫唑嘌呤、氯氨丁苯、环孢菌素、皮质类固醇、秋水仙碱、沙利度胺和己酮可可碱。肿瘤坏死因子-a是一种重要的细胞因子，在自身免疫性疾病的免疫发病机制中发挥重要作用(4)。英夫利昔单抗(ifliximab，IFX)是一种抗肿瘤坏死因子-α的嵌合单抗，自21世纪初以来一直用于治疗炎症性肠病。文献中有几个报告显示了IFX在Behçet-Associates中的成功使用
Behçet disease (BD) is a chronic, relapsing, multisystem inflammatory disorder characterized by recurrent oral and genital ulcers, cutaneous lesions, and uveitis (1). Rare manifestations include gastrointestinal involvement, arthritis, seizures, and vascular lesions. Gastrointestinal involvement of BD is termed entero-Behçet syndrome and mainly affects the ileocecal region and colon. The involvement of perianal area by aphthous lesions is a rather rare clinical presentation of BD and is usually confined to childhood. The most common symptoms of entero-Behçet syndrome are abdominal pain, nausea, vomiting, diarrhea with or without blood in the stool, and constipation (2). The gastrointestinal manifestations of BD usually appear 4 to 6 years after the onset of the oral ulcers. The intestinal lesions are usually resistant to medical treatment and recur frequently after surgical therapy. Reported frequencies of gastrointestinal involvement vary regionally from zero in a study in Israel to 60% in a study in Japan, with a frequency of 2.8% to 5% in Turkey (3).The principal aim in the treatment of BD is the modification of inflammatory response. Several drugs are used in the treatment of BD such as azathioprine, chlorambucil, cyclosporine, corticosteroids, colchicine, thalidomide, and pentoxifylline. Tumor necrosis factor-a (TNF-a) is an important cytokine that plays an important role in immunopathogenesis of autoimmune diseases (4). Infliximab (IFX) is a chimeric monoclonal antibody against TNF-a and has been used for the treatment of inflammatory bowel disease since the beginning of the 21st century. There are several reports in the literature showing the successful use of IFX in Behçet-associated